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Unwanted Advances

Unwanted Advances. Sexuality Case. Presentation. 75-year old ambulatory male Routinely touches female staff members when they are bathing, toileting or dressing him No particular staff members as targets Says “I’m sorry” when CNAs ask him to stop, then does it again

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Unwanted Advances

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  1. Unwanted Advances Sexuality Case

  2. Presentation • 75-year old ambulatory male • Routinely touches female staff members when they are bathing, toileting or dressing him • No particular staff members as targets • Says “I’m sorry” when CNAs ask him to stop, then does it again • Now seen touching a female resident in her room

  3. Ongoing Medical Conditions • Dementia • Heart disease • High blood pressure • Hypothyroidism • Enlarged prostate/ incontinence • Skin cancer • Constipation • Arthritis • Restless Leg Syndrome

  4. Recent Medical Issues • None

  5. Medications • Aricept and Namenda • Lasix • Metoprolol • Synthroid • Flomax • Senna/MOM/Fleets/Colace • Ultram/APAP/Vicodin • Mirapex

  6. Medical Assessment • Possible causes • Medical conditions • Medication-induced hyperthyroidism • Dementia • Elevated testosterone level • Mania • Delirium • Medications • Mirapex

  7. Medical Assessment • Laboratory tests • CBC and BMP are normal • UA is normal • Thyroid tests are normal • Testosterone level is low

  8. Medical Management • Assumed to be secondary to dementia • 5-10% of dementia patients display hypersexuality • Mirapex discontinued • Clonazepam added for RLS • No other medication changes made • Possible use of other medications • No FDA indication • Certain antidepressants • Hormone treatment

  9. Nursing Management • The resident is noted to target younger CNAs and nurses • More mature caregivers • Male caregivers employed when possible • Use a white jacket, other props • To more fully identify the female caregiver as a nurse • Scheduled caregiving • Rapid, safe completion of task • Care plan protocol for this issues posted in medical chart, on MAR

  10. Nursing Management • Patient monitored in public areas • Behavior documented on an hourly basis • Encouraged to sit with male residents or less vulnerable females • Male staff help as much as possible with activities, meals • No mixed messages sent • More physically demonstrative female staff encouraged to refrain from supportive hugs, hand holding, using terms of endearment (“Honey”) with the resident • Firm, clear and calm redirection • “Please stop” rather than “That’s inappropriate”

  11. Nursing Management • Make sure is not misidentification • Believes person(s) are spouse or girlfriend • Make sure nursing assistant concerns are addressed • Embarrassment • Disgust • Education about this as part of the illness is a must • Uncomfortable for residents, staff and families

  12. Outcome • Elimination of Mirapex • May have been helpful • No need to move onto other agents • Nursing interventions • Cut down on frequency of events • No further incidents with other residents • New staff orientation discussed these issues • Care plan placed on chart, on MAR, for nursing staff less familiar with resident was effective

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